Biopsies Should Not Be Replaced in Diagnosis of Breast Cancer
The United States Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ) has recently issued a report stating that the four common non-invasive tests for breast cancer-MRI, PET, ultrasound, or scintamammography-are not accurate enough to replace breast biopsies in women who have abnormal findings on a mammogram or physical examination.
Breast cancer is diagnosed in approximately 250,000 women annually in the United States alone. Breast cancer is typically detected when a lump is found on a woman’s breast. The lump may be discovered through self examination and during an exam by a physician. Mammographic screening is also used to detect masses in the breast. A woman will then undergo a breast biopsy, a procedure in which some cells or the entire lump is removed and examined in a laboratory for the presence of cancerous cells.
The large majority (four out of five) women who have lumps detected in their breast have a benign (non-cancerous) mass. Among these women, breast biopsies are performed unnecessarily. Researchers continue to evaluate ways to minimize the use of biopsies since these procedures are associated with pain, use medical resources, increased medical cost, and the time of both healthcare provider and patient. In addition, patients often have to wait for results, causing considerable anxiety.
Researchers have been evaluating non-invasive methods that may distinguish between cancerous and non-cancerous masses within the breast. Methods include magnetic resonance imaging (MRI), ultrasound, positron emission tomography (PET) scans, or scintimammography. If effective, their use may reduce unnecessary biopsies. However, the AHRQ has recently established that these non-invasive methods would miss an unacceptable rate of cancer; biopsy thus remains the standard approach for diagnosing breast cancer.
- For every 1,000 women who had a negative MRI, about 962 would have avoided an unnecessary biopsy, but 38 would have missed cancers.
- For every 1,000 women who had a negative ultrasound test, about 950 women would have avoided an unnecessary biopsy, but 50 women would have missed cancers.
- For every 1,000 women who had a negative PET scan, about 924 women would have avoided an unnecessary biopsy, but 76 women would have missed cancers.
- For every 1,000 women who had a negative scintimammogram, about 907 women would have avoided an unnecessary biopsy, but 93 women would have missed cancers.
The researchers conclude that women who have breast lumps detected by physical examination or mammography should undergo a breast biopsy to accurately distinguish between cancer and a benign condition.
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